The overall objective of this study is to determine the impact of in utero cocaine exposure upon perinatal outcome and neurodevelopmental consequences in the infant. The study and control groups will be drawn from an inial survey population of 2,250 North American black women delivering at the University of Miami/Jackson Memorial Hospital (UM/)JMH). A detailed substance abuse history, maternal and infant urine toxicology assays, and serologic testing for human immunodeficiency virus (HIV-1) will be performed at delivery. The association between maternal cocaine use and adverse perinatal outcome, including prematurity, intrauterine growth retardation, abruptio placenta, and fetal demise will be assessed. A prospective longitudinal study will be performed to assess neurobehavioral status, neurodevelopmental outcome and auditory function, of 250 cocaine- exposed term infants compared to two groups of control term infants. The first control group (n=125) will include infants unexposed to cocaine but exposed to alcohol and/or marijuana. The second control group (n=125) will be drug-free, i.e. unexposed to cocaine, alcohol, or marijuana. Physical and neurologic examinations will be performed during the delivery hospitalization and at 1,6,12,18, and 24 months and yearly thereafter. The Motor Assessment Inventory will be performed at 4 months. Bayley Scales of Infant Development will be administered at 6,12,18, and 24 months. Stanford-Binet will be utilized at 3 and 4 years. Auditory brainstem evoked response (ABR) will be performed at birth with repeat ABR at 1 month if abnormal. Behavioral audiology assessments will be performed at 1 and 3 years. Echoencephalographic studies will be obtained during the first postnatal week and at 1 and 6 months postnatal month and at 9 and 21 months postnatal week and at 1 and 6 months postnatal age. Cranial magnetic resonance imaging (MRI) will be performed in the first postnatal month and at 9 and 21 months postnatal age to complement echoencephalography in detecting parenchymal abnormalities and to delineate myelination patterns in all infants with abnormal echoencephalograms and in 40 randomly selected infants without abnormal echoencephalographic findings (20 in the cocaine- exposed group and 10 in each control group). Serial ABR will also be performed at 1,4,9, and 21 months in all infants undergoing serial MRI studies. Future efforts at developing strategies to combat perinatal cocaine use and minimize its impact upon exposed infants should be enhanced by the project.